- Humana (Austin, TX)
- …scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post… more
- Charter Care Health Partners (North Providence, RI)
- …Director Care Management or designee. Provides coordinated care support to Physician leadership and Clinical Manager(s) of respective services. Makes daily rounds ... specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management; Continuum of Care Management (Discharge… more
- Elevance Health (FL)
- …outside of the client health plan network. + Notifies ordering physician or rendering service provider office of the preauthorization determination decision. ... ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or… more
- CenterWell (Temple, TX)
- …care plans and interpreting patient needs, while adhering to Company, physician , and/or health facility procedures/policies. + Manages the assignment of caregivers. ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- Elevance Health (Costa Mesa, CA)
- …outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. ... ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or… more
- CenterWell (Charleston, WV)
- …care plans and interpreting patient needs, while adhering to Company, physician , and/or health facility procedures/policies. + Manages the assignment of caregivers. ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- CVS Health (MO)
- …that primarily supports the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management) Medical Director will be a "Work from Home" position primarily ... review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent review. Cases… more
- Providence (Fortuna, CA)
- …management functions across acute care ministries, including case management, utilization management, discharge planning, and social work services. You'll ensure ... objectives. + **Operational Leader:** Direct and oversee care management, utilization management, discharge planning, and psychosocial interventions. + **Collaborative… more
- Houston Methodist (The Woodlands, TX)
- …and federal programs + Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement ... benefits for patients and reimbursement for the hospital. + Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource … more
- Providence (Anchorage, AK)
- …Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation of ... Surgical or Inpatient setting + IRR or annual competency testing in Utilization Review **Preferred Qualifications:** + Bachelor's Degree in Nursing or higher within… more